TOP5 is supported by research showing that practical, carer‑led strategies improve communication, reduce distress and help staff provide care that reflects the person’s needs and preferences. The program has been used across hospitals, residential care, community services and supported accommodation, with positive outcomes for carers, staff and the people they support.
Evidence behind TOP5
Research and evaluation have shown that TOP5:
- improves communication between carers and staff
- reduces confusion, anxiety and distress
- supports smoother transitions between care settings
- increases staff confidence when responding to behavioural or communication needs
- strengthens partnerships between carers and health professionals
- helps staff provide care that aligns with what matters to the person
TOP5 has been recognised as a practical, person‑focused tool that supports safe, respectful care across diverse environments.
Where TOP5 has been used
TOP5 has been successfully implemented in:
- hospitals
- residential aged care
- community health and disability services
- supported accommodation
- home‑based care
- education and early childhood settings
- workplace support for staff with disability or cognitive needs
The flexibility of TOP5 allows it to be adapted to different environments while keeping the person’s needs at the centre of care.
What research shows
Studies and evaluations highlight that TOP5:
- helps staff understand the person more quickly
- reduces the need for reactive or crisis‑based responses
- supports consistent care across shifts and services
- improves the experience of carers during hospital stays or transitions
- enhances staff awareness of communication and sensory needs
Carers report feeling more included and valued, and staff report feeling better equipped to support people with complex needs.
Practice insights
TOP5 works best when:
- carers and staff collaborate to create strategies
- strategies are simple, practical and easy to follow
- TOP5 is visible and accessible to all staff
- strategies are reviewed and updated when needs change
- information is shared across services during transitions
These practices help ensure TOP5 remains relevant and effective.
Using TOP5 in your service
Services can embed TOP5 by:
- introducing TOP5 during admission or intake
- including TOP5 in handover processes
- displaying TOP5 where staff can easily see it
- reviewing strategies regularly
- encouraging carers to share insights early
- training staff on how to use TOP5 effectively
TOP5 can be adapted to suit the needs of any service or setting.
Publications & conference papers
Issac,L M., Buggy. E., Sharma, A., Karberis, A., Maddock, K M., Weston, K. (2018). Enhancing hospital care of patients with cognitive impairment.
Keane, S. TOP5 – Engaging carers in person centred care for people with confusion and / or communication difficulties. Abstract – Australian Association of Gerontology conference. April, 2008. Available from: Top 5- engaging carers in person centred care for inpatients with confusion
Luxford, K., Axam, A., Hasnip,F., Dobrohodoff, J., Strudwick, M., Reeve, R., Hou, C & Viney, R. (2015) Improving clinician-carer communication for safer hospital care: a study of the “TOP5” strategy in patients with dementia International Journal for Quality in Health Care, 1–8. Available from: “TOP5” strategy in patients with dementia (PDF)
